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OB > Chapter 8 - Intrapartum Assessment + Interventions > Flashcards

Chapter 8 - Intrapartum Assessment + Interventions Flashcards

1
Q

Premonitory Signs of Labor

A
  • backache
  • rupture of membrane
  • wt loss (1-3.5 lb)
  • lightening
  • regular contractions
  • incr discharge/bloody show
  • energy burst
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2
Q

lightening

A

As the fetus’s head settles deep into your pelvis, you may feel that the fetus has dropped lower

  • you can breath again!
  • but now u may be peeing more
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3
Q

ways to confirm ROM

A
  • speculum exam
  • ferning
  • amnisure testing (detects PAMG-1, an amniotic fluid)
  • nitrazine paper (turns blue w amniotic fluid)
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4
Q

nursing actions if ROM is suspected

A
  • assess FHR
  • assess amniotic fluid for color, amt, odor
  • document date + time SROM + assessments
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5
Q

amniotic fluid characteristics

A

clear or cloudy w normal odor like ocean water

-if meconium stained, then contact HCP bc it may indicate fetal compromise in utero

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6
Q

Mechanisms of Labor are the…

A

positional changes in the presenting part required to navigate the birth canal
-aka cardinal mvmt

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7
Q

Mechanisms of Labor is composed of…

A
  • engagement
  • descent
  • flexion
  • internal rotation
  • extension
  • external rotation/Restitution
  • expulsion
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8
Q

engagement

A

when the greatest diameter of the head passes thru the PELVIC INLET
-late pregnancy, early labor

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9
Q

descent

A

mvmt of bb thru birth canal during 1st + 2nd stages of labor

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10
Q

flexion

A

when chin of bb moves towards chest

  • happens when head meets resistance fr tissue
  • early in labor
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11
Q

internal rotation

A

when long axis of the head lies along axis of the pelvis

-2nd stage of labor

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12
Q

extension

A

head pivots underneath the pubic symphysis

  • caused by resistance of pelvic floor
  • during 2nd stage, when head is delivered
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13
Q

external rotation/Restitution

A

head + shoulders rotate to move under symphysis pubis

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14
Q

expulsion

A

anterior shoulder comes first followed by the rest of the body

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15
Q

6 best practices that promote normal physiological birth

A 
1 labor starts on its own
2 freedom of mvmt 
3 continuous support
4 minimize interventions
5 spontaneous pushing in non-supine
6 no separation bw bb + mom
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16
Q

4 stages of Labor

A

1 start: onset of labor, end: complete dilation
2 start: complete dilation, end: bb delivery
3 start: after deliver of bb, end: delivery of placenta
4 start: after delivery of placenta, end: 4 hrs later. aka postpartum period

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17
Q

characteristics of 1st stage of labor

A
  • longest stage
  • bag of waters or fetal membrane usually ruptures
  • incr in CO + pulse
  • decr in GI motility
  • pain assoc w UC
  • 3 phases
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18
Q

nursing actions of 1st stage of labor

A
  • limit oral intake to clear liquids
  • woman dictates carb intake to decr ketosis
  • frequent position changes + upright
  • frequent emptying of bowel/bladder
  • comfort measures
  • emo + phys support
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19
Q

phases in first stage of labor

A

latent: <5cm
active: >6cm
transition: 8-10 cm

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20
Q

nonpharm actions

A
  • emo stupport
  • comfort measures (ice chips, fluids, food)
  • hygiene (pericare, mouth careO
  • position changes
  • touch/massage
  • calm environment
  • advocacy
  • reinforce relaxation/breathing
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21
Q

latent phase of stage 1

A
  • dilatn 0-4cm
  • effacement 0-40%
  • mild contractions Q 5-10 min (like strong menstrual cramps)
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22
Q

nursing actions in latent phase

A
  • start IV or insert saline lock
  • double check Rh, GBS, urine for protein/gluc
  • assess (VS, FHR, UC, membrane status, amniotic fluid, edema, hrt lung sounds,
  • sterile vaginal exam: dilatn + effcmt, presentation, position, station
  • leopold maneuver
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23
Q

leopold maneuver

A

assess position of bb

  • determines what part of fetus is in fundus
  • location of fetal back
  • presenting part
  • location of cephalic prominence
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24
Q

if GBS is pos…

A

give IV of penicillin

-ampicillin is alt

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25
Q

sterile vaginal exam directions

A
  • labia is separated w sterile glove hand
  • fingers are lubed
  • locate cervix
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26
Q

sterile vaginal exam assesses….

A
  • dilation
  • effacement
  • position
  • station
  • presentation
  • fetal position
27
Q

dilation in SVE

A

sweep finger fr side to side on margin of cervical opening

28
Q

effacement in SVE

A

estimates shortening of cervix fr 2cm to paper-thin

29
Q

position in SVE

A

relationship of cervix to head

-posterior, midposition, or inferior

30
Q

station Iin SVE

A

level of presenting part in birth canal

  • 0 when presenting part reaches ISCHIAL SPINE
  • (-) still inside, (+) when outside
31
Q

presentation in SVE

A

cephalic, breech, shoulder

32
Q

ferguson’s reflex

A

urge/readiness to bear down

  • phys response of women
  • activated when presenting part is at least 1+ station
33
Q

when is intrapartum GBS prophylaxis indicated?

A
  • previous bb w invasive GBS disease
  • GBS bacteria during current pregnancy
  • pos GBS vaginal-rectal culture in late gestation
  • unknown GBS status at onset of labor w <37 nwks
  • ROM> 18hrs
  • temp >100.4
34
Q

s/s of active phase of 1st stage of labor

A
  • > 6cm
  • decr energy, fatigue
  • contractions more intense, Q 2-5min, lasts 45-60 sec
35
Q

nursing actions for active phase of 1st stage of labor

A
  • FHR + contractions Q 15-30 min
  • VS Q2 hr
  • –Q1 hr if rom
36
Q

transition phase of 1st stage of labor

A
  • complete dilation
  • easily discouraged, irritable
  • intense contractions Q 1-2 min, lasts 60-90 sec
  • incr bloody show
  • backache
  • strong urge to bear down or push
37
Q

if pt has backache…

A

hand goes over hip, rubbing + pressing on area

38
Q

nursing actions for transition phase of 1st stage of labor

A
  • FHR + UC Q 15 min

- breathe during contractions + rest bw contractions

39
Q

2nd stage of labor phases

A

latent/resting: urge to bear down is usually absent, fetus is passively descensding

descent/active phase: incr intensity of UC + strong activation of ferguson’s reflex

40
Q

bearing down in the __ stage is less tiring + more effective + when started after the ___ rather than before

A

2nd stage> ferguson reflex (stron gurge to bear down)

41
Q

2nd stage of labor characteristics

A

intense UC Q2min lasting60-90 sec

  • bloody show incr
  • perineum flattens
42
Q

pushing education

A
  • push for 6-8 seconds, followed by slight exhale
  • repeat for 3-4 pushes per contraction
  • discourage traditional practice of breath holding for 10 secs w each contraction
43
Q

perineal stretching care for 2nd stage of labor

A
  • warm compress

- gentle massage w warm oil

44
Q

Episiotomy

A

incision in perineum to provide more space

45
Q

Types of Episiotomy

A

1 median/midline

2 medilateral

46
Q

median/midline episiotomy

A

heals more quickly w less discomfort

47
Q

medilateral episiotomy

A

45 degree angle incision

  • heals more slowly
  • greater blood loss
  • more painful
48
Q

Lacerations

A

tears in the perineum

-can occur in cervix, vagina, perineum

49
Q

1st degree Lacerations

A

perineal skin + vaginal mucous membrane

50
Q

2nd degree Lacerations

A

skin, mucous membrane, FASCIA of perineal

51
Q

3rd degree Lacerations

A

skin, mucous membrane, MUSCLE of perineal, EXTENDS TO SPHINCTER

52
Q

4th degree Lacerations

A

extends to RECTAL MUCOSA + exposes LUMEN of rectum

53
Q

3rd Stage of Labor

A

separation + expulsionof placenta

  • sudden decr in uterus size
  • UC continues until placenta is expelled
54
Q

Active Management of Third stage of Labor + goals

A
  • uterotonic drug (OXYTOCIN)
  • controlled cord traction
  • fundal massage

goal is to decr PPH + incr UC + placenta expulsion

55
Q

normal blood loss

A

500 mL w/in 24 hr

56
Q

3rd stage of labor nursing actions

A
  • at delivery, bb is placed on mom for skin-to-skin
  • if 3rd stage lasts more than 30 min, IV/IM of oxytocin 10IU
  • if placenta is still retained, then manual removal
  • if manual removal is being performed, then prophylactic abx is admin
57
Q

primary mechanism to return to hemostasis

A

vasoconstrictions fr well contracted myometrium

58
Q

when is apgar score obtained?

A

1 min, 5 min

-if apgar score is less than 7, then Q5min for 20 min

59
Q

3 meds routinely administered to newborn

A

1 erythromycin
2 vitamin K
3 hepatitis B

60
Q

erythromycin

A

ointment admin to eyes as prophylaxis ointment

-prevents gonococcal + chlamydia infections

61
Q

vitamin K

A

via IM injection

-prevents hemorrhagic disease caused by vit K deficiency

62
Q

Hep B vaccine

A

recommended for all newborns

63
Q

initial assessment of newborn

A

airway, breathing, circulation, drug

OB (18 decks)

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